| Code | Article | DDD | U | AWaRe | Age | unit_per_course |
|---|---|---|---|---|---|---|
| DINJAMPI1V- | AMPICILLIN, 1g, powder, vial | 6.00 | g | Access | 5 years or more | 6 |
| DINJAMPI5V- | AMPICILLIN, 500mg, powder, vial | 2.00 | g | Access | Under 5 years | 6 |
| DINJCEFA1V- | CEFAZOLIN, 1g, (IV), powder, vial | 3.00 | g | Access | 5 years or more | 6 |
| DINJCLOX5VV | CLOXACILLIN sodium, eq. 500mg base, powder, vial IV | 2.00 | g | Access | 5 years or more | 6 |
| DINJGENT8A- | GENTAMICIN sulfate, eq. 40mg/ml base, 2ml, amp. | 0.24 | g | Access | 5 years or more | 6 |
| DINJMETN5BF | METRONIDAZOLE, 5mg/ml, 100ml, bag/bottle PVC free | 1.50 | g | Access | 5 years or more | 5 |
| DINJPENB2VS | BENZATHINE BENZYLPENICILLIN, 2.4 MIU, powder, vial + solvent | 3.60 | g | Access | 5 years or more | 4 |
| DORAAMOC22TD | AMOXICILLIN 200mg/ CLAVULANIC acid, 28.5mg, disp. tab. | 1.50 | g | Access | Under 5 years | 14 |
| DORAAMOC4S5 | AMOXICILLIN 400mg / CLAV.ac. 57mg/5ml, powd.oral susp. 70ml | 1.50 | g | Access | Under 5 years | 1 |
| DORAAMOC56T | AMOXICILLIN 500mg / CLAVULANIC acid, 62.5 mg, tab. | 1.50 | g | Access | 5 years or more | 18 |
| DORAAMOC81T | AMOXICILLIN 875mg / CLAVULANIC acid 125mg, tab. | 1.50 | g | Access | 5 years or more | 14 |
| DORAAMOX1S1 | AMOXICILLIN, 125mg/5ml, powder oral susp., 100ml, bot. | 1.50 | g | Access | Under 5 years | 1 |
| DORAAMOX2TDB | AMOXICILLIN, 250mg, dispersible and breakable tab. | 1.50 | g | Access | Under 5 years | 21 |
| DORAAMOX5T- | AMOXICILLIN, 500mg, tab. | 1.50 | g | Access | 5 years or more | 21 |
| DORACEFX2C- | CEFALEXIN, 250mg, caps. | 2.00 | g | Access | 5 years or more | 56 |
| DORACLOX2C- | CLOXACILLIN sodium, eq. 250mg base, caps. | 2.00 | g | Access | 5 years or more | 56 |
| DORACLOX5C- | CLOXACILLIN sodium, eq. 500 mg base, caps. | 2.00 | g | Access | 5 years or more | 28 |
| DORADOXY1T- | DOXYCYCLINE salt, eq. 100mg base, tab. | 0.10 | g | Access | 5 years or more | 10 |
| DORAMETN2S- | METRONIDAZOLE benzoate,eq.200mg/5ml base,oral susp,100-120ml | 2.00 | g | Access | Under 5 years | 1 |
| DORAMETN2T- | METRONIDAZOLE, 250mg, tab. | 2.00 | g | Access | 5 years or more | 20 |
| DORAMETN5T- | METRONIDAZOLE, 500mg, tab. | 2.00 | g | Access | 5 years or more | 20 |
| DORANITR1T- | NITROFURANTOIN, 100mg, tab. | 0.20 | g | Access | 5 years or more | 14 |
| DORATINI5T- | TINIDAZOLE, 500mg, tab. | 2.00 | g | Access | 5 years or more | 4 |
Antibiotics in PHCs & MCs
OCBA - SYRIA Mission
Analyzing supplies of antibiotics from June to December 2023 against the data extracted from HMIS
2023-05-15
Context
- Armed conflict with lots of displacements
- Working through partnership of DoH and local NGOs (MSF is NOT the direct implementer of services).
- Two projects: IDAL and NAP
- Supporting PHCs, MCs, BEmONCs and CEmONCs
- Regular monthly medical donations based on the facilities consumption
- AMR and Antibiotics over-prescribing are quiet spread in Syria
objectives
- Evaluate the antibiotic usage:
is there Antibiotics over-prescribing in Facilities? where? how much? how often? - Evaluate the rational prescribing behavior:
are first line of ABs prescribed (Access group) or skipped to second line (Watch group) immediately? - Double check the balance between antipyretic courses and antibiotics courses?
Data resources
- Monthly donations extracted from Isystock (it is based on the facilities monthly consumption)
- Export HMIS data for all health facilities (HF) for concerned period.
- Age:
- Under 5 years U5.
- 5 years or more O5.
- consultation categories:
- Total consultations.
Parameters
- define the Antibiotics list in the mission and its category based on WHO AWaRE categorization (Access, Watch)
- define Age categories of those medications:
- Under 5 years U5 (pediatrics: Suspension, Syrups, dispersible tablets and pediatrics injectables
- 5 years or more O5: Tablets and injectables for adult
- Define the Duration of treatment based on MSF1 (the average duration of treatment of the main indication of the drug)
- WHO DDD: Daily defined dose is the assumed average maintenance dose (grams) per day for a drug used for its main indication in adults.
- Calculation of number of units of medication per course
- Under 5 years U5:
each bottle of suspension or syrup are 1 course.
- Under 5 years U5:
- 5 years or more O5:
DDD * DoT / (dose of medication per unit in grams) Amoxicillin 500 mg =>
DDD is 1.5 gram => duration of treatment is between 5 to 7 days =>
7 (duration of treatment)* 1.5 (DDD)/ 0.5 (dose of medicine per unit in grams) = 21 tablets
Amoxicillin 500mgcourse is 21 tablets.
Access group antibiotics
Watch group antibiotics
| Code | Article | DDD | U | AWaRe | Age | unit_per_course |
|---|---|---|---|---|---|---|
| DINJCEFO5V- | CEFOTAXIME sodium, eq. 500mg base, vial | 2.0 | g | Watch | Under 5 years | 6 |
| DINJCEFT1V- | CEFTRIAXONE sodium, eq. 1g base, powder, vial | 2.0 | g | Watch | 5 years or more | 6 |
| DINJCEFT2V- | CEFTRIAXONE sodium, eq. 250mg base, powder, vial | 2.0 | g | Watch | Under 5 years | 3 |
| DORAAZIT2T- | AZITHROMYCIN, 250mg, tab. | 0.3 | g | Watch | 5 years or more | 6 |
| DORAAZIT3S- | AZITHROMYCIN, 200mg/5ml, powder oral susp., 30ml, bot. | 0.3 | g | Watch | Under 5 years | 1 |
| DORAAZIT5T- | AZITHROMYCIN, 500mg, tab | 0.3 | g | Watch | 5 years or more | 3 |
| DORACEFI2S- | CEFIXIME, 100mg/5ml, powder for oral susp., 60 ml, bot. | 0.4 | g | Watch | Under 5 years | 1 |
| DORACEFI2T- | CEFIXIME, 200 mg, tab. | 0.4 | g | Watch | 5 years or more | 10 |
| DORACIPR2T- | CIPROFLOXACIN hydrochloride, eq. 250mg base, tab. | 1.0 | g | Watch | 5 years or more | 20 |
| DORACIPR5T- | CIPROFLOXACIN hydrochloride, eq. 500mg base, tab. | 1.0 | g | Watch | 5 years or more | 14 |
| DORAERYT5T- | ERYTHROMYCIN stearate, eq. 500mg base, tab. | 1.0 | g | Watch | 5 years or more | 18 |
| DORAFOSF3S- | FOSFOMYCIN trometamol, eq. 3g base, sachet | 3.0 | g | Watch | 5 years or more | 1 |
Antibiotic Mission view
Mission’s ratio of Access to Watch - 5 years or more
Mission’s Percentage of Antibiotics & Antipyrretics to consultations - 5 years or more
Mission’s ratio of Access to Watch - Under 5 years
Mission’s Percentage of Antibiotics & Antipyrretics to consultations - Under 5 years
there is a downtrend in Antibiotic consumption in category 5 Years and more throughout the analysis period. (improvement)
the consultation rate is almost stable of category 5 years and more. (improvement)
the trend of antibiotic consumption of category under 5 years is stable somehow. (neutral)
ratio of Watch group to Access group is still high in under 5. (neutral)
rate of Antibiotic consumption in Under 5 years is almost double the 5 years and more. (neutral)
Access vs Watch AB
IDAL Project view
steep drop in consuption of AB in last summer season the stable low consmption of AB, Accepted ratio (Access to Watch)
surge in Watch ratio (Access to Watch) since starting supporting the NICU in Dec
decline in AB consumption (look suspiciously low in last 6 months)
there is downtrend in total without any change in the ratio (Access to Watch)
there is steep decline in AB consumption since the Earthquake in Feb
steep decline in watch group since Feb (investagation is needed)
uptrend in AB consumption with two Surges (Feb and Apr), to improve the ratio (Access to Watch)
uptrend in AB consumption since Jan, the ratio (Access to Watch) needs improvement
ratio (Access to Watch) needs improvements
ratio (Access to Watch) needs improvements, suspicioius surge in Jun
downtrend since Dec, good ratio (Access to Watch) also
stable AB consumption and good ratio (Access to watch)
downtrend and improvement in AB consumption and ratio (Access to Watch)
decline in AB since Apr with good ratio (Access to Watch) overall
NAP Project view
ratio of (Access to Watch) close to each others, two surges one in Feb EQ and the other last summer
stable AB consumption with surge in Feb EQ, the ratio (Access to Watch) needs improvement
Inverted ratio (Access to Watch), Investigate
ratio (Access to Watch) needs improvements, Investage Oct surge
Inverted Ratio (Access to Watch), Investage
uptrend in watch (CLOSED)
acceptable ratio (Access to Watch) (CLOSED)
high fluctuations in AB and the ratio (Access to Watch)
fluctuation in AB and ratio (Access to Watch)
increase in watch in last three months (almost inverted ratio)
acceptable ratio (Access to Watch)
acceptable ratio (Access to Watch)
acceptable ratio (Access to Watch)
high ratio of Watch (equal)
good ratio (Access to Watch)
Percentage of AB prescription to consultation
IDAL project view
very good cooporation and response
since Jan they stoped collecting paed data only from NICU
very good ratios
good ratio
decline in AB ratio since Feb, WHY?
high consumption of AB in winter months and less, invistgate April surge in antipyrrtic
this PHC is growing in all terms (consultations and consumption)
very high consumption since March (almost evey chil is given AB and antipyretic
new facility, good ratio
new facility, Investigate June data
there is noticeable imporvement and still there window for more improvement
NO noticicable improvement (need strict actions)
AB consumption is improving
good improvement and ther is still a window for more
NAP Project view
good ratio
good ratio
good ratio
good ratio
unstable nr of consultaion, to check the data?
good ratio, CLOSED
always growing consumption, CLOSED
good ratio
good ratio, investagate Feb surge
good ratio
good ratio, check last months surge in antipyretics
good ratio
acceptable ratio, investigate last 2 months surge
good ratio
very high AB consumption rate
Percentage of AB prescription to infectious cases
IDAL project view
very good cooporation and response
since Jan they stoped collecting paed data only from NICU
very good ratios
good ratio
decline in AB ratio since Feb, WHY?
high consumption of AB in winter months and less, invistgate April surge in antipyrrtic
this PHC is growing in all terms (consultations and consumption)
very high consumption since March (almost evey chil is given AB and antipyretic
new facility, good ratio
new facility, Investigate June data
there is noticeable imporvement and still there window for more improvement
NO noticicable improvement (need strict actions)
AB consumption is improving
good improvement and ther is still a window for more
NAP Project view
good ratio
good ratio
good ratio
good ratio
unstable nr of consultaion, to check the data?
good ratio, CLOSED
always growing consumption, CLOSED
good ratio
good ratio, investagate Feb surge
good ratio
good ratio, check last months surge in antipyretics
good ratio
acceptable ratio, investigate last 2 months surge
good ratio
very high AB consumption rate
Observation & Recommendations
Observations:
Recommendations:
Syria Mission’s PHC and MC Antibiotics analysis